Abstract: Advance care planning is a crucial part of end of life medical care. It can take many forms, including designation of a surrogate decision maker via a DPOA document. However it can also involve living wills, physicians orders for life sustaining treatment (POLSTs), or even simply clinician patient conversation. The newly revised hospital policy on advance directives reflects this broader approach. The talk will include a brief review of the philosophical and ethical basis of advance care planning before diving into a discussion of the new hospital policy and it's impact on practice.

Reshma Jagsi’s survey of high-achieving physician-scientists published in JAMA, found that nearly a third of women reported experiencing sexual harassment. As women now make up about half of medical school students, the researchers emphasize the importance of recognizing unconscious bias as well as overtly inappropriate behaviors.

Kenneth Langa's national study, published in JAMA Internal Medicine, was cited in a New York Times article discussing US dementia trends. Despite concern that dementia rates were increasing, Langa found that it is actually decreasing. He found that population brain health seemed to improve between 2000 and 2012 and that increasing educational attainment and better control of cardiovascular risk factors may have contributed to the improvement. However, the full set of social, behavioral, and medical factors contributing to the improvement is still uncertain.

Brian Zikmund-Fisher, Sarah Hawley, Reshma Jagsi and others were recently published in a JAMA Oncology research letter on breast cancer patient risk communication. They found that medical oncologists were found to be far more likely than surgeons to quantify risk estimates for patients and that patients who do not see a medical oncologist may make treatment decisions, including surgery, without all relevant risk information.

Beth Tarini is lead author on study published in the Journal of Pediatrics that found that few primary care physicians say they would order genetic testing or refer a child to a genetics specialist as a first step when they see children with two or more developmental delays, despite the higher risk of genetic disorders in these children.

Raymond De Vries is involved in a new research study led by Akbar Waljee, MD, MSc, which will develop a risk-based strategy to help providers tailor timing of treatments among CHC Veterans to ensure that those who most need urgent therapy get it as quickly as possible.

Using democratic deliberation, Dr. De Vries will engage Veterans to learn their thoughts and preferences about such a strategy, which will help with its implementation in a clinical setting.

A study on surgeon influence on double mastectomy co-authored by Sarah Hawley and Reshma Jagsi was recently highlighted in Time Health. This study found that attending surgeons exerted a substantial amount of influence on the likelihood of receipt of contralateral prophylactic mastectomy after a breast cancer diagnosis. Steven Katz was first author of this study.

In light of the #MeToo campaign denouncing sexual assault and harassment, Reshma Jagsi has written a perspective piece in the New England Journal of Medicine about sexual harrassment in academic medicine. Also check out her interview in MHealth Lab and several other articles citing her NEJM article.

Susan Goold is the senior author in a newly published study in JAMA, in which 2,500 U. S. physicians were asked about their views on 17 specific strategies to reduce health care spending, including proposed policies in the Patient Protection and Affordable Care Act. They were also surveyed on their perceived roles and responsibilities in addressing health care costs as care providers.

The vast majority of U.S. physicians (85 percent) agreed that trying to contain costs was a responsibility of every physician but most respondents prioritized patients’ best interests over cost concerns. Most surveyed physicians supported cost-containment initiatives aimed at improving the quality and efficiency of care, such as promoting chronic disease care coordination and limiting corporate influence on physician behavior. Substantial financing reforms, however, were much less popular among physicians. Examples include bundled payments, penalties for readmissions, eliminating fee-for-service reimbursement and other Medicare pay cuts. Physicians also believed that patients, pharmaceutical companies, and malpractice lawyers shared as much or more of the responsibility for containing escalating healthcare costs.

Jon C. Tilburt, M.D., M.P.H., of the Mayo Clinic, Rochester, Minn., was lead author of the study.

The CBSSM Research Colloquium featured the Bishop Lecture in Bioethics as the keynote address. Myra Christopher presented the Bishop Lecture with a talk entitled: "The Moral Imperative to Transform the Way Pain is Perceived, Judged and Treated".

Myra Christopher holds the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics. Prior to December 2011, Ms.

Christopher was President and CEO of the Center for Practical Bioethics since its inception in 1984 through December 2011. From 1998-2003, Christopher also served as the national program officer of the Robert Wood Johnson Foundation’s National Program Office for State-based Initiatives to Improve End-of Life Care which was housed at the Center. These roles have allowed Christopher to continue her lifelong mission to improve care for those who are seriously ill and their families.

Since the late 1990s, Christopher has expanded the scope of her work to include the under treatment of chronic pain. She is currently the Director of the Pain Action Initiative: A National Strategy (PAINS) and serves as Chair of the PAINS Steering Committee. From 2010-2011 she served as a member of Pain Study Committee at the Institute of Medicine focused on the under-treatment of pain. In 2012 she was appointed by the Secretary of Health and Human Services, Kathleen Sibelius, to the Interagency Pain Research Coordinating Committee (IPRCC) at the National Institutes of Health. In that capacity, she also serves on the Oversight Committee for the National Pain Strategy Task Force.

The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium was held Thursday, May 15, 2014 at the Vandenberg Meeting Hall (2nd floor), The Michigan League, 911 N. University Ave, Ann Arbor, MI 48109.